Correspondence to the SCC

From Nate Pettinger, MD:

Dear Clinicians:

We have parents of a neonate who has been diagnosed with Cystic Hygromas. We are asking if anyone has seen or heard of an infant with this diagnoses and if there is any medical information regarding use of topical or oral use of cannabis (CBD) for this situation of an infant with over fifty external lesions? Any suggestions or ideas would be appreciated. Thank you.

From Robert Schulman, MD RH(AHG): A video about a doctor in Australia who was forced to give up his medical license registration to pursue his medical cannabis research and practice.

Dupuytren’s contracture involves thickening of fibrous bands (cords) of skin and underlying tissue in the palm (palmar fascia) that can result in the band shortening. As the bands contract, the fingers pull down into the palm (flexion contracture). The bands are so strong that the individual becomes unable to straighten his or her involved fingers.Dupuytren’s contracture is a hereditary disorder. Severity varies, with some individuals developing only nodules (bumps in palm) without the flexion contractures.—The Reed Group

46-year-old male carpenter with slowly progressing Dupuytren’s contacture of his right 3rd finger was advised to try using a home made concentrated cannabis salve with an occlusive barrier (nitrile glove) at bedtime in order to reduce daytime pain. Patient returned one year later for his medical cannabis recommendation with near complete resolution of the contracture.

Pain Scale (after treatment): 1

Patient information

Otherwise healthy non-smoker.

History & Symptomatology

Several-year progression of palmar fascia and flexor tendon contracture of the right third finger was making it more and more difficult for this patient to swing a hammer on the job. He was looking for a non-psychoactive alternative for daytime pain relief. Exam found a classic thickened and deformed palmar fascia with firm bead deformities of the flexor tendon.

Previous Therapies

Massage, splinting.

Cannabis Therapy

Method of administration: Topical cannabis cream was applied liberally to the entire palmar surface of the affected hand which was then covered by a single rubber glove and worn overnight then removed and washed in the morning.He was not ingesting or smoking/vaporizing cannabis.

Frequency of Usage

Times per day 1, days per week 7

Cannabis strain highTHC/low CBD strain by description, but not tested.

Clinical Response

Patient reported that after several weeks of bedtime cannabis salve and a glove the contracture had nearly entirely resolved. When seen by me one year later he had near normal extensor range of motion, preserved flexor range of motion, normal appearance and no palpable deformity.

Comments

Dupuytre’s contractures may in part be due to upregulation of myofibroblasts. This article [http://www.ncbi.nlm.nih.gov/pubmed/24312195] describes the endocannabinoid system as a mediator of mesenchymal stromal cell immunosuppressive properties.

Here is the only other case [http://www.ncbi.nlm.nih.gov/pubmed/1402277] of non-surgical resolution that I could find, this with continuous passive traction. Interestingly, it calls for “further …. pharmacological studies.”

He used a homemade salve.I always advise using coconut oil plus DMSOHe was uninsured at the time and couldn’t afford surgery though he wanted to.Lucky guy!

Dr. Lovejoy is a specialist in distinguishing authentic from fake art and antiques.